Making the diagnosis:clinical diagnosis based on history of persistent and disabling anxiety or emotional distress in relation to social situations, including(1)marked and persistent fear of situations in which patient is exposed to unfamiliar people or possible scrutiny, fear of doing something humiliating or embarrassing, or showing anxiety symptomsanxiety almost always provoked by exposure to feared social situationpatient recognizes fear as excessive or unreasonablephobic situation avoided or endured with intense anxiety or distressavoidant behavior interferes with occupational functioning, social activities, or presence of marked distress about having fearsymptoms persist > 6 months if < 18 years oldfear not due to physiological effect of substance or another psychiatric disorder and is unrelated to comorbid medical conditionsDifferential diagnosis:nonpathological shyness and performance anxiety(1, 2)several conditions may need to be ruled out as either principal diagnosis or comorbidity(1, 2)generalized anxiety disorderpanic disorderagoraphobia (fear of being in places or situations where escape might be difficult or embarrassing rather than fear of social situations)specific phobiamajor depressionautism spectrum disordersbipolar disorderbody dysmorphic disorderschizophreniaschizoid personality disorderavoidant personality disorderschool refusal and separation anxiety disorderselective mutismorganic causes of medical conditions that might create discomfort in social situations(1, 2)Parkinson diseasedisfigurementessential tremorobesitystutteringTesting overview:no specific testing necessary